Healthcare Provider Details

I. General information

NPI: 1518058023
Provider Name (Legal Business Name): EDWARD DELMAR BAKER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1669 W AVENUE J 305
LANCASTER CA
93534-2866
US

IV. Provider business mailing address

45054 ANDALE AVE
LANCASTER CA
93535-2655
US

V. Phone/Fax

Practice location:
  • Phone: 661-942-1181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD023089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: